| 1. |
- Attar, Rubina, et al.
(författare)
-
Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia
- 2020
-
Ingår i: Open Heart. - : BMJ. - 2053-3624. ; 7:2
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy.PURPOSE: To investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure).METHODS: All patients with schizophrenia who experienced AMI during 2000-2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2 85 325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations.RESULTS: Patients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p<0.005). AMI patients with schizophrenia had higher adjusted risk of MACE (aHR=2.05, 95% CI 1.63 to 2.58), mortality (aHR=2.38, 95% CI 1.84 to 3.09) and hospitalisation for heart failure (aHR=1.39, 95% CI 1.04 to 1.86) compared with AMI patients without schizophrenia.CONCLUSION: Patients with schizophrenia experienced an AMI almost 10 years earlier than patients without schizophrenia. They less often underwent invasive procedures and were less likely to be treated with guideline recommended medications at discharge, and had more than doubled risk of MACE and all-cause mortality. Improved primary and secondary preventive measures, including adherence to guideline recommendations, are warranted and may improve outcome.
|
|
| 2. |
- Attar, Rubina, et al.
(författare)
-
Peripheral artery disease and outcomes in patients with acute myocardial infarction
- 2019
-
Ingår i: Open heart. - : BMJ. - 2053-3624. ; 6:1, s. e001004-
-
Tidskriftsartikel (refereegranskat)abstract
- To describe the population of patients with previously diagnosed peripheral artery disease (PAD) experiencing a myocardial infarction (MI) and to investigate 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure hospitalisation) following MI.BackgroundMI patients with PAD constitute a high-risk population with adverse cardiac outcomes. Contemporary real-life data regarding the clinical characteristics of this patient population and clinical event rates following MI remain scarce.MethodsThis observational study included all MI patients presenting with ST-elevation MI or non-ST-elevation MI between 01 January 2005 and 31 December 2014 with (n=4213) and without (n=106 763) a concurrent PAD diagnosis, identified in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and the National Patient Registry (PAD prevalence: 3.8%). Cox proportional hazard models were applied to compare the outcome between the two populations.ResultsMI patients with PAD were older and more often burdened with comorbidities, such as diabetes, hypertension and previous MI. After adjustments, PAD was significantly associated with higher rates of MACE (HR 1.35, 95% CI 1.27 to 1.44), mortality (HR 1.59, 95% CI 1.43 to 1.76), reinfarction (HR 1.48, 95% CI 1.32 to 1.66), stroke (HR 1.27, 95% CI 1.05 to 1.53), heart failure (HR 1.29, 95% CI 1.20 to 1.40) and bleeding (HR 1.26, 95% CI 1.09 to 1.47) at 1 year.ConclusionA concurrent PAD diagnosis was independently significantly associated with higher rates of adverse outcomes following MI in a nationwide real-life MI population. The low prevalence of PAD compared with previous studies suggests significant underdiagnosing. Future studies should investigate if PAD screening with ankle–brachial index may increase diagnosing and subsequently lead to improved treatment of polyvascular disease
|
|
| 3. |
- Görtz, Morgan, 1994, et al.
(författare)
-
Network model for predicting structural properties of paper
- 2022
-
Ingår i: Nordic Pulp & Paper Research Journal. - : Walter de Gruyter GmbH. - 0283-2631 .- 2000-0669. ; 37:4, s. 712-24
-
Tidskriftsartikel (refereegranskat)abstract
- Paper simulations that resolve the entire microscopic fiber structure are typically time-consuming and require extensive resources. Several such modeling approaches have been proposed to analyze different properties in paper. However, most use non-linear and time-dependent models resulting in high computational complexity. Resolving these computational issues would increase its usefulness in industrial applications. The model proposed in this work was developed in collaboration with companies in the papermaking industry within the Innovative Simulation of Paper (ISOP) project. A linear network model is used for efficiency, where 1-D beams represent the fibers. Similar models have been proposed in the past. However, in this work, the paper models are three-dimensional, a new dynamic bonding technique is used, and more extensive simulations are evaluated. The model is used to simulate tensile stiffness, tensile strength, and bending resistance. These simulated results are compared to experimental and theoretical counterparts and produce representable results for realistic parameters. Moreover, an off-the-shelf computer accessible to a paper developer can evaluate these models structural properties efficiently.
|
|
| 4. |
- Hegmar, Hannes, et al.
(författare)
-
Liver stiffness predicts progression to liver-related events in patients with chronic liver disease - A cohort study of 14 414 patients
- 2024
-
Ingår i: Liver international. - : WILEY. - 1478-3223 .- 1478-3231.
-
Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) is a non-invasive diagnostic biomarker of liver fibrosis. It is uncertain if LSM can predict risk for future liver-related outcomes in large, heterogenous populations. Methods: This Swedish multi-centre cohort study included patients (n = 14 414) from 16 sites who underwent LSM by VCTE between 2008 and 2020. Outcomes were ascertained from national registers. We investigated progression to cirrhosis with portal hypertension or hepatocellular carcinoma (HCC), separately. Cox regression was used to obtain hazard ratios (HRs). Harrel's C-index was used to measure discrimination of VCTE. Results: Included patients had a median age of 46 (interquartile range 34-57), median LSM of 5.9 kPa (4.6-8.0), 59% were male, and the majority had hepatitis C (50.1%). During a median follow-up of 5.9 (4.3-8.0) years, 402 patients (2.7%) developed cirrhosis with portal hypertension. In patients with an LSM >= 25 kPa, 28.7% developed cirrhosis with portal hypertension within 5 years of follow-up, while only .6% of patients with an LSM <10 kPa did. This translated to a HR of 48.3 (95% confidence interval = 37.6-62.0). VCTE had a high discriminative ability, with C-indices above .80 for most liver diseases, including .82 for MASLD. Similar findings were seen for incident HCC. Conclusions: Increased LSM by VCTE was associated with an increased risk of progression to both cirrhosis with portal hypertension, and to HCC, and had a high discriminative ability across different aetiologies of chronic liver diseases. These results support the use of VCTE to guide follow-up and treatment decisions.
|
|
| 5. |
- Holmer, Magnus, et al.
(författare)
-
Effect of common genetic variants on the risk of cirrhosis in non-alcoholic fatty liver disease during 20 years of follow-up
- 2022
-
Ingår i: Liver international (Print). - : Wiley. - 1478-3223 .- 1478-3231. ; 42:12, s. 2769-2780
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Aims Several genotypes associate with a worse histopathological profile in patients with non-alcoholic fatty liver disease (NAFLD). Whether genotypes impact long-term outcomes is unclear. We investigated the importance of PNPLA3, TM6SF2, MBOAT7 and GCKR genotype for the development of severe outcomes in NAFLD. Method DNA samples were collected from 546 patients with NAFLD. Advanced fibrosis was diagnosed by liver biopsy or elastography. Non-alcoholic steatohepatitis (NASH) was histologically defined. Additionally, 5396 controls matched for age, sex and municipality were identified from population-based registers. Events of severe liver disease and all-cause mortality were collected from national registries. Hazard ratios (HRs) adjusted for age, sex, body mass index and type 2 diabetes were estimated with Cox regression. Results In NAFLD, the G/G genotype of PNPLA3 was associated with a higher prevalence of NASH at baseline (odds ratio [OR] 3.67, 95% CI = 1.66-8.08), but not with advanced fibrosis (OR 1.81, 95% CI = 0.79-4.14). After up to 40 years of follow-up, the PNPLA3 G/G genotype was associated with a higher rate of severe liver disease (adjusted hazard ratio [aHR] 2.27, 95% CI = 1.15-4.47) compared with the C/C variant. NAFLD patients developed cirrhosis at a higher rate than controls (aHR 9.00, 95% CI = 6.85-11.83). The PNPLA3 G/G genotype accentuated this rate (aHR 23.32, 95% = CI 9.14-59.47). Overall mortality was not affected by any genetic variant. Conclusion The PNPLA3 G/G genotype is associated with an increased rate of cirrhosis in NAFLD. Our results suggest that assessment of the PNPLA3 genotype is of clinical relevance in patients with NAFLD to individualize monitoring and therapeutic strategies.
|
|
| 6. |
- Kettil, Gustav, 1990, et al.
(författare)
-
A Multiscale Method for Discrete Fiber Network Models
- 2018
-
Ingår i: 6th European Conference on Computational Mechanics (Solids, Structures and Coupled Problems). 7th European Conference on Computational Fluid Dynamics, 11-15 June 2018, Glasgow, UK.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The mechanics of paper depends on the properties of its fibers and bonds. Modeling paper as a network [1] will include effects of single fibers and bonds, capturing heterogeneous properties. In the ISOP (Innovative Simulation of Paper) project at Fraunhofer-Chalmers Centre, the forming process is simulated [2, 3]. To investigate the mechanical properties of the resulting simulated paper sheets a network approach is utilized. Numerical investigation of fiber networks is demanding due to the large number of fibers and bonds, fluctuation of their properties, and the non-regular network structure. Multiscale methods are useful tools to circumvent such problems. In this work a multi-scale approach for fiber networks is developed, based on a FEM-method for continua [4]. Consider a fiber network governed by a model resulting in an equation Kx = F, where K describes the network properties, x are node displacements, and F are applied forces. The idea of the multi-scale method is to consider a subset of all nodes, denoted coarse nodes, which in turn represents a coarse grid. At each coarse node a basis function is defined similarly as in the finite element method. By solving a system including the coarse nodes an approximation would be attained, however this approximation would leave out the fine scale effects of the heterogeneous network. Instead the coarse basis functions are modified by solving a local system at each coarse node, including surrounding fine nodes. These modified basis functions are thereafter used when solving the global system, resulting in an approximation of the network displacements now including effects from the fine scale.
|
|
| 7. |
- Kettil, Gustav, 1990, et al.
(författare)
-
A Multiscale Methodology for Simulation of Mechanical Properties of Paper
- 2020
-
Ingår i: Proceedings of the 6th European Conference on Computational Mechanics: Solids, Structures and Coupled Problems, ECCM 2018 and 7th European Conference on Computational Fluid Dynamics, ECFD 2018. - 9788494731167 ; 2020, s. 2795-2806
-
Konferensbidrag (refereegranskat)abstract
- In this work a multiscale framework developed for simulation of mechanical properties of paper is presented. The framework consists of two major parts. In the first part the forming process of a paper machine is simulated using the fiber suspension model developed in [8]. Fluid dynamics together with an advanced contact calculation method enables detailed simulation of the lay down process. The resulting paper sheet is used as input to the second part of the framework. In the second part the fiber configuration attained from the unique forming simulations is transformed into a network representation, enabling simulation of mechanical properties. The paper mechanics is governed by a fiber network model. To study macroscale properties a novel numerical upscaling method for networks has been developed. In this paper the complete simulation methodology is outlined and discussed.
|
|
| 8. |
- Kettil, Gustav, et al.
(författare)
-
Numerical upscaling of discrete network models
- 2020
-
Ingår i: BIT (Copenhagen). - : Springer Science and Business Media LLC. - 0006-3835 .- 1572-9125. ; 60:1, s. 67-92
-
Tidskriftsartikel (refereegranskat)abstract
- In this paper a numerical multiscale method for discrete networks is presented. The method gives an accurate coarse scale representation of the full network by solving sub-network problems. The method is used to solve problems with highly varying connectivity or random network structure, showing optimal order convergence rates with respect to the mesh size of the coarse representation. Moreover, a network model for paper-based materials is presented. The numerical multiscale method is applied to solve problems governed by the presented network model.
|
|
| 9. |
- Nasr, Patrik, et al.
(författare)
-
Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis
- 2024
-
Ingår i: Clinical Gastroenterology and Hepatology. - : ELSEVIER SCIENCE INC. - 1542-3565 .- 1542-7714. ; 22:5
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Alcohol overconsumption is a risk factor for disease progression in patients with presumed metabolic dysfunction-associated steatotic liver disease (MASLD). How commonly this occurs and how it affects progression to major adverse liver outcomes (MALOs) is not well known. METHODS: We did a register-based cohort study, including all patients with a diagnosis of MASLD in Sweden between 1987 and 2020. Patients were strati fi ed on co-occurrence of diagnoses of alcohol-related liver disease (ALD) or alcohol use disorder (AUD) prior to MASLD diagnosis. Incident MALOs were derived from national registers. Cox regression was used to calculate hazard ratios (HRs) for incident MALO. RESULTS: A total of 15,107 patients with MASLD were identi fi ed. The median age was 55 years, and 52% were female. Of the patients, 1843 (12%) had a prior diagnosis of ALD or AUD. During followup, a further 787 patients (5.2%) received a diagnosis of ALD or AUD. Patients with previous ALD or AUD diagnoses at or before baseline had considerably higher rates of MALOs compared with patients without (19.5% vs 7.8%; adjusted HR, 3.12; 95% con fi dence interval, 2.74 - 3.55). Acquiring an ALD or AUD diagnosis after MASLD diagnosis was associated with higher rates of MALOs (adjusted HR, 5.81; 95% con fi dence interval, 4.90 - 6.88). CONCLUSIONS: ALD or AUD is commonly diagnosed prior to or after MASLD diagnosis. Such patients have considerably higher rates of progression to MALOs. Correctly separating between MASLD and ALD is vital to assess prognosis.
|
|
| 10. |
- Viitanen, Matti, 1950-
(författare)
-
Long-term effects of stroke
- 1987
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death.Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined.The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems.
|
|
